ABSTRACT
BACKGROUND: The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB). METHODS: We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding. RESULTS: Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR]â=â1.27, 95% confidence interval [CI] [1.09-1.49], Pâ=â.002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RRâ=â1.02, 95%CI [0.91-1.16], Pâ=â.71) and hematospermia (RRâ=â0.93, 95%CI [0.82-1.06], Pâ=â.29). CONCLUSION: Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.
Subject(s)
Aspirin/adverse effects , Biopsy, Needle/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Aspirin/administration & dosage , Clinical Trials as Topic , Gastrointestinal Hemorrhage/chemically induced , Gastrointestinal Hemorrhage/etiology , Hematuria/chemically induced , Hematuria/etiology , Hemospermia/chemically induced , Hemospermia/etiology , Humans , Male , Platelet Aggregation Inhibitors/administration & dosage , Prostate/pathology , Prostatic Neoplasms/pathology , Ultrasonography, InterventionalSubject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/therapeutic use , Hemospermia/chemically induced , Propylamines/adverse effects , Adult , Atomoxetine Hydrochloride , Drug Administration Schedule , Humans , Male , Methylphenidate/therapeutic useABSTRACT
AIM: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. RESULTS: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. CONCLUSION: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications.
Subject(s)
Aspirin/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/chemically induced , Prostate/pathology , Ultrasonography, Interventional/adverse effects , Urologic Surgical Procedures, Male/adverse effects , Aged , Biopsy/adverse effects , Biopsy/methods , Case-Control Studies , Hematuria/chemically induced , Hematuria/epidemiology , Hemospermia/chemically induced , Hemospermia/epidemiology , Humans , Male , Postoperative Hemorrhage/epidemiology , Prospective Studies , Prostate/diagnostic imaging , Rectal Diseases/chemically induced , Rectal Diseases/epidemiology , Risk Factors , Ultrasonography, Interventional/methods , Urologic Surgical Procedures, Male/methodsABSTRACT
OBJECTIVES: To determine whether the incidence and duration of bleeding complications after transrectal prostate biopsy (PB) in patients not discontinuing low-dose aspirin (LDA) are greater than in those discontinuing it. METHODS: A total of 200 consecutive subjects taking chronic LDA were enrolled in a prospective trial and were randomly assigned to undergo transrectal PB while continuing LDA (group 1, n = 67), replacing LDA with low-molecular-weight heparin (group 2, n = 67), or discontinuing LDA (group 3, n = 66). The incidence and duration of hematuria, rectal bleeding, and hematospermia for each group were assessed with a self-administered questionnaire. On days 14 and 30 after PB, all men were evaluated with an outpatient visit and a telephone interview, respectively. RESULTS: The cohort comprised 196 assessable subjects. The median number of biopsy cores taken was 10 (range 6 to 10). The overall bleeding rate was 78.5%, 69.7%, and 81.5% in groups 1, 2, and 3, respectively (P = 0.26). No significant difference was found for hematuria, rectal bleeding, or hematospermia among the groups. No severe bleeding complications occurred. The median duration of hematuria and rectal bleeding was significantly greater statistically in groups 1 and 2 compared with group 3 (6, 4, and 2 days versus 3, 2, and 1 days, respectively; P <0.0001). The proportion of men still reporting hematospermia at 30 days after PB was 21.4%, 18.5%, and 9.3% in groups 1, 2, and 3, respectively (P = 0.2). CONCLUSIONS: The continued use of LDA in men undergoing transrectal PB did not increase the incidence of mild bleeding complications, although it prolonged the duration of self-limiting hematuria and rectal bleeding. Its effect, however, on severe bleeding remains to be determined.
